A 38-year-old lawyer is referred to the Electrophysiology Clinic following an episode of near-syncope. He was discovered to have an abnormal ECG  when he was 30 year old, during a routine assessment after he applied for life insurance. The ECG findings remain unchanged:

• Sinus rhythm, 78/min
• ST elevation compatible with Brugada pattern (type I)
• The computer ECG program had diagnosed “acute myocardial infarct”

The near-syncope occurred while the patient was in a crowded subway train. He did not lose consciousness and had no palpitation. The associated symptoms and the clinical sequence were typical of a vasovagal  episode. He had a similar episode 7 years ago. His paternal grand-mother had been known to have a type I Brugada ECG pattern, but had died at age 94 of non-cardiac disease.  

The patient is aware of the risk of sudden death associated with the Brugada syndrome and is concerned.  His two episodes of near-syncope, however, are most likely vasovagal and benign. He will continue to be followed by his family physician. He has been informed that his ECG pattern may be misdiagnosed as “myocardial infarction”. He has been advised to carry a copy of his ECG and of a clinical note, particularly if he travels away from home.